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Paediatric Respiratory Assessment Cheat Sheet by

Details how to assess a child's respiratory status and the signs of the stages of respiratory failure.

PEWS - ABCDEFG

A
Airway
Is the airway patent­/ma­int­ain­abl­e/c­omp­rom­ised? Is there difficulty breath­ing­/sp­eaking? Are there associated breath sounds?
B
Br­eathing
Look, Listen, Feel: Look - count RR; assess respir­atory effort (i.e. use of accessory muscles, nasal flaring, abnormal rhythm, etc.); body position; colour. Listen - noisy breathing = upper airway secret­ions; strido­r/w­heeze = partial airway obstru­ction; grunti­ng/­gas­pin­g/a­pnoea. Feel - for deform­ities (i.e. surgical emphysema, crepitus).
C
Ci­rcu­lation
Record HR, measure CRT, BP.
D
Di­sab­ility
Asses neurol­ogical status - alert/­voi­ce/­pai­n/u­nre­spo­nsive; pupil size; glucose; Glasgow Coma Scale (older children).
E
Ex­posure
Temper­ature (consider core/p­eri­phe­ries); rash; pain; skin integrity (blood loss, lesions, wounds, drains); consider fluid balance
DEFG
Don't Ever Forget Gl­ucose
According to PEWS chart. RR = respir­atory rate. HR = heart rate. BP= blood pressure. CRT = cap refill time.
 

Signs of Deteri­oration

Abnormal RR/effort
Outside usual parameters for age group.
Recess­ion­/ac­cessory muscle use
Subcos­tal­/in­ter­costal recession; tracheal tug.
Abnormal breath sounds
Strido­r/w­heeze
Pulse Oximetry
Value below 96%.
Oxygen Therapy
Need for inspired oxygen.
Call for help if head bobbin­g­/­gru­nti­ng­/­ga­spi­ng­/­ap­noe­a­/­central cyanosis noted
RR = respir­atory rate.

Respir­atory Failure

Initial stages
Physio­logical cause:
Attempt to compensate O2 deficit & airway obstru­ction; beginning hypoxia
 
Signs
Restle­ssness; tachyp­noea; tachyc­ardia; diapho­resis
Imminent respir­atory failure
Physio­logical cause:
Attempt to use accessory muscles to assist intake O2; persistent hypoxia; use up more O2 than obtained
 
Signs
Tachyp­noea, dyspnoea & tachyc­ardia; nasal flaring ; retrac­tions; grunti­ng/head bobbing; wheezing; hypoxia (<92%); difficulty speaking; anxiet­y/i­rri­tab­ility; mood changes; headache; confusion
Ominous imminent respir­atory arrest
Physio­logical cause:
Overwh­elming O2 deficit; cerebral oxygen­ation affected (CNS changes ominous imminent respir­atory arrest)
 
Signs
Severe hypoxia (pO2 <60%); dyspno­ea/­bra­dyp­noe­a/s­ilent chest/­apnoea; bradyc­ardia ; cyanosis; stupor­/coma
pO2 = oxygen satura­tions.
 

Other Diagnostic Tests

SaO2 satura­tions
Arterial blood gas
Bloods
FBC - WCC slightly raised
Blood gases
pH 7.35-7.45; pO2 75-100mmHg (10-13.3kPa); pCO2 36-46mmHg (4.8-6.1kPa); Bicarb­onate HCO3 22-30m­mol­/L-1; Base excess -2.3 - +2.3mmol/L
Chest x-ray
Spirometry
PEF; FEV1
Common abnorm­alities
Respir­atory acidosis: pCO2 and HCO3 increased, pH and pO2 decreased.
SaO2 = oxygen satura­tions. FBC = full blood count. WCC = white cell count. pO2 = partial pressure oxygen. pCO2 = partial pressure carbon dioxide. PEF = peak expiratory flow. FEV1 = forced expiratory volume in 1 second.
 

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  • Published: 17th August, 2017

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